L-dopa is a potent stimulator of cortisol in short children

AIMS

In this study, we evaluated the diagnostic usefulness of oral L-dopa as a stimulatory agent for cortisol.

METHODS

In 27 short children that were evaluated for possible growth hormone deficiency (GHD), the levels of serum GH and cortisol were determined after oral L-dopa administration and after i.m. glucagon administration. We defined cortisol concentrations >18 μg/dl (496 nmol/l) as adequate response. Peak GH concentration <10 ng/ml in both tests defined GHD.

RESULTS

Twenty-five out of the 27 children (93%) studied showed a normal cortisol response, i.e. a peak serum cortisol >18 μg/dl in the L-dopa test, whereas 19 children (70%) had a normal cortisol response after stimulation with glucagon. In the children with normal cortisol response in both tests, the mean peak serum cortisol concentration was 28.7 (SD 1.59) after L-dopa and 26.65 (SD 1.26) μg/dl after glucagon administration. There was no statistically significant difference in peak serum cortisol response to L-dopa between GH-deficient and GH-sufficient children [25.90 (SD 4.9) vs. 29.87 (SD 9.9) μg/dl, respectively].

CONCLUSIONS

These results clearly suggest that L-dopa administration is a potent stimulus for cortisol secretion at least in short children.

The diversity of juvenile sarcoidosis symptoms

We report a case of juvenile sarcoidosis, emphasizing the variety of clinical manifestations. The child had uveitis, which is among the most common manifestations of the disease. However, fever of unknown origin, glomerulonephritis and lymphadenopathy were also noticed, underscoring the diversity of the clinical spectrum of the disease.

Menetrier's disease associated with Helicobacter pylori: three cases with sonographic findings and a literature review

Menetrier's disease is a rare cause of protein-losing gastropathy characterised by hypertrophy of the gastric folds. Three cases are reported. Helicobacter pylori was detected by culture and CLO test in two cases and on follow-up gastroscopy in the other. The first two patients were given eradication therapy and hypertrophic gastropathy resolved whereas in the third the disease remitted prior to the eradication treatment. Typical sonographic features were thickened gastric wall with preservation of the wall stratification. A review of the literature found eight cases of Menetrier's disease associated with H. pylori in children and these cases are briefly reviewed. H. pylori infection should be considered in all children with Menetrier's disease and, if isolated, eradication treatment should be administered.

Uveitis: an isolated complication of post-streptococcal syndrome

A child with anterior uveitis as the sole manifestation of group A streptococcal infection is described. There was a history of a 'viral' upper respiratory tract infection 2 weeks before the onset of uveitis. A post-streptococcal phenomenon was diagnosed on the basis of serial ASO titre (ASOT) monitoring. There are few reports of patients with post-streptococcal uveitis. ASOT monitoring should be included in the work-up of uveitis of undetermined aetiology.

Is there an association between wheezing and pneumonia?

OBJECTIVE

The aim of this study was to investigate whether there is a relationship in school aged children between wheezing and pneumonia prior, during, or following the pneumonia episode.

PATIENTS-METHODS

One hundred and three children with community acquired pneumonia who were hospitalised were recruited along with 55 controls.

RESULTS

During hospitalisation wheezing was audible in 11/103 (10.6%) patients with pneumonia and in none of the controls (p=0.009). Wheezing ever or asthma was elicited in 29/103(28%) patients with pneumonia and in 8/55 (14.5%) of the controls and this difference was not significant. Two years after the hospitalisation with pneumonia, wheezing episodes occurred in 12/103 with pneumonia and 1/55 of the controls (p=0.034). Among those who developed asthma following pneumonia 11/12 also had wheezing prior to pneumonia.

CONCLUSION

There is an excess of wheezing prior, during, and after an episode of pneumonia in school aged children and therefore children with pneumonia should be followed up carefully.

Long term follow up of a woman with classic form of Ehlers-Danlos syndrome associated with rare manifestations and review of the literature

We present the case of a 46 year-old woman with the classic type of Ehlers-Danlos syndrome who developed the rare manifestations of colon diverticula and mitral valve prolapse. We emphasize on clinical features and complications associated to this type of the syndrome, which gradually developed in our patient. A review of the literature referring to the epidemiology, molecular basis and manifestations of the classic type Ehlers-Danlos syndrome is also discussed.

Splitting the dose of neonatal BCG vaccination: a naïve practice

Bilateral axillary lymphadenitis complicating BCG vaccination in both arms (0.025 ml) in an immunocompetent 13-month-old boy is described. Prompt administration of isoniazid and erythromycin did not prevent suppuration of the affected lymph nodes. It was managed by bilateral surgical excision of the nodes.

Clinical notations on bacteremic cavitating pneumococcal pneumonia in nonvaccinated immunocompetent children

We describe 10 children who developed lung cavitation during the treatment of bacteremic pneumococcal lobar pneumonia. Chest CT scan showed extensive consolidation with several small lucencies and air-filled cavities. Invasive procedures like aggressive pleural intervention were not needed and the children recovered attaining normal lung function on long-term follow-up.

Prevalence of overweight and obesity in young Greek men

We determined the prevalence of overweight and obesity in young Greek men in 2006 and examined variations related to their place of residence and educational level. Body height and weight were measured in 2568 conscripts of the Greek army, aged 19-26 years. The calculated body mass index (BMI, kg m(-2)) was correlated to their socio-demographic characteristics, i.e. level of education and place of residence (urban or rural). Overweight and obesity were defined according to the World Health Organization classification. Mean BMI (standard deviation) of the conscripts was 24.7 (4.2). The prevalence of overweight (30 > BMI > or = 25 kg m(-2)) was 28.5% and correlated positively with a higher educational level, whereas the prevalence of obesity (BMI > or = 30 kg m(-2)) was 10.4% and correlated positively with a lower educational level. Our data were compared with those of similar studies performed in the years 1969: BMI 23.8 (1.4) (P < 0.0001) and 1990: BMI 23.8 (2.9) (P < 0.0001), showing a positive secular trend for BMI in Greek conscripts in the last 16 years. In conclusion, we documented an alarmingly high prevalence of overweight and obesity among young Greek men.

Maturational tempo differences in relation to the timing of the onset of puberty in girls

AIM

To determine maturational tempo differences related to the timing of pubertal onset in girls.

METHODS

We studied longitudinally 307 prepubertal Greek schoolgirls. Age at onset of puberty (B2), peak height velocity (PHV) and age at menarche were recorded. Age at onset of puberty quartiles were determined in order to define girls as early maturers (<9.2 years) and late maturers (>10.6 years). Due to dropout from the study, results for menarche are reported for 182 girls.

RESULTS

Median (1st-3rd quartile) time span from B2 to PHV was longer for early maturers than for average and late maturers, 1.6 (1.0-2.2) years, 1.1 (0.7-1.7) years and 0.9 (0.3-1.1) years, respectively, p < 0.001). There was no significant difference in PHV, in the time interval from PHV to menarche and in adult height (for 75 girls) with respect to whether girls matured early, average or late.

CONCLUSION

A compensatory delay in the maturational tempo in early-maturing girls and a catch-up mechanism in late-maturing girls was shown. The maturational differences manifest as differences in the time span from the onset of puberty to PHV. Early pubertal maturation in girls does not compromise adult height and is not always followed by early menarche.

Clinical expression of co-inherited Dubin-Johnson and thalassaemic heterozygous states

Dubin-Johnson syndrome is a worldwide prevalent familial conjugated hyperbilirubinaemia. The identification of multidrug resistance-associated protein 2 provided an understanding of the complex metabolic impairment involved in this syndrome. We report the first family with modified clinical expression of Dubin-Johnson heterozygous state due to genotypic interaction with co-inherited beta and deltabeta thalassaemia, an interaction that has never been described.

Steroid hormones polymorphisms and cholelithiasis in Greek population

BACKGROUND

Genetic variation in genes involved in steroid biosynthesis, metabolism and signal transduction have been suggested to play a role in gallstone disease.

METHODS

To elucidate the possible role of genetic variation in the estrogen receptors alpha and beta (ER-alpha, ER-beta) and androgen receptor (AR) genes in breast cancer risk, the -1174(TA)n, c.1092+3607(CA)(n) and c.172(CAG)n repeat polymorphisms of the three genes were studied. A case-control cohort of 99 patients with cholelithiasis and 179 controls were used.

RESULTS

No significant difference was observed in the frequency distribution of -1174(TA)(0-26) in the ER-alpha gene between patients and controls, while a significant difference was observed in the frequency distribution of repeat polymorphism c.1092+3607(CA)5-27 and c.172(CAG)5-32 in the ER-beta gene and AR gene, respectively (P< or =0.001 and P=0.05, respectively). A significant difference was observed in the repeat genotype distribution (SS, SL, LL) in the (CA)n of the ER-beta gene (P<0.0001) and in the (CAG)n of the AR gene (P< or =0.0001). A significantly decreased odds ratio for cholelithiasis risk was observed in individuals having the SL and LL genotype for ER-beta gene compared with SS genotype (OR=0.212; 95% CI 0.105-0.426; P<0.0001 and OR=0.042; 95% CI 0.018-0.097, respectively) and LL genotype for AR gene (OR=0.622; 95% CI 0.345-1.121; P=0.114 and OR=0.287; 95% CI 0.151-0.543, P<0.0001, respectively). This protective effect of SL and LL genotypes for ER-beta and LL for AR gene remained evident (P<0.0001 for all of them) even after adjustment for various risk factors.

CONCLUSIONS

In conclusion an association for cholelithiasis risk between short alleles for both c.1092+3607(CA)5-27 and c.172(CAG)5-32 repeat polymorphisms of the ER-beta and AR was found in individuals of Greek descent.

The effect of inhaled budesonide on adrenal and growth suppression in asthmatic children

The present authors evaluated adrenal reserve in asthmatic children on long-term inhaled corticosteroids and whether possible adrenal suppression could be predicted by growth retardation. Low-dose synacthen test (0.5 microg x 1.73 m(-2)) was performed in 72 asthmatic children with a median age of 9.4 (range 4.2-15.7) yrs on long-term treatment (median 18 (range 6-84) months) with low-to-moderate doses (median 363 (range 127-1012) microg x m(-2)) of inhaled budesonide, as well as in 30 controls. Adrenal suppression was considered as a peak serum cortisol <495 nmol x L(-1). The current authors calculated height standard deviation score (HSDS) at the time of testing and height velocity SDS (HVSDS) in the preceding year. Mean HSDS was 0.06+/-1.3 and HVSDS was -0.9+/-2.3. Adrenal suppression was disclosed in 15 asthmatic children (20.8%). There were no differences in HSDS and HVSDS between children with and without adrenal suppression. There was no correlation between peak cortisol response and dose or duration of treatment. However, a positive relationship between HVSDS and duration of treatment was noted. These data suggest that long-term treatment of asthmatic children with low and moderate doses of inhaled budesonide may result in mild adrenal suppression that cannot be predicted by growth deceleration. The negative influence of inhaled corticosteroids on growth becomes less the longer the duration of treatment.

Invasive meningococcal disease presenting as Henoch-Sch�nlein purpura

Henoch-Schonlein purpura (HSP) is an acute systemic form of vasculitis that has been associated with a number of viral and bacterial infections. Described here are the cases of two children with invasive meningococcal disease who presented with clinical and laboratory findings typical of HSP. Meningococcal infection may have been the trigger for the manifestation of HSP in these patients.

Splenic granulomatous lesions in immunocompetent pediatric patients with visceral leishmaniasis

Visceral focal lesions are rarely encountered in patients with leishmaniasis despite the fact that splenomegaly, and to a lesser extent hepatomegaly, predominate among the clinical features of the disease. We present, using high resolution ultrasonography, the first 3 reported cases of focal splenic involvement in immunocompetent children with visceral leishmaniasis. All patients showed a prompt response to the conventional anti-leishmanial treatment administered. This favorable outcome indicates that localized splenic lesions should not be considered as a poor prognostic factor and that alteration of the standard anti-leishmanial regimens is not justified.

Unsuspected extralymphocutaneous dissemination in febrile cat scratch disease

Cat scratch disease (CSD) commonly manifests as regional self-limited lymphadenitis. However, dissemination of the infection to distant multiple sites may occur even in immunocompetent patients. We report a series of 11 children with fever and extralymphocutaneous manifestations of CSD, in order to highlight potential multiorgan involvement in patients with febrile CSD. To be eligible for enrollment, patients had to present with involvement of sites other than regional lymph nodes. The diagnosis was based on suggestive clinical criteria, histological findings and positive serology. The utilization of ultrasound imaging revealed hepatic lesions in 3 children and splenic lesions in 8 children, whereas osteolytic lesions were observed in 4 children by bone scan. Hepatic or splenic involvement was not suggested by clinical signs or biochemical investigation in 2/3 and 6/8 children, respectively. Bone involvement was supported either by relative symptoms or signs. Our findings indicate that, in the presence of fever, extralymphocutaneous manifestations have to be anticipated in patients with clinically suspected CSD. The systematic use of imaging modalities in patients with serologically documented Bartonella henselae infection could contribute to a better understanding of the clinical spectrum of CSD.

Circulating cytokines in patients with cat scratch disease

Levels of circulating interleukin (IL)-2, IL-6, and IL-10, measured by enzyme-linked immunosorbent assay, were significantly higher in patients with cat scratch disease (CSD) than in healthy control subjects; no induction of IL-12 was observed, and levels of interferon-gamma and IL-4 were generally not detectable. This is the first report showing increased circulating cytokine levels in patients with CSD. The induction of these mediators can partly explain some clinical and pathological features of the disease.

Polymorphonuclear elastase as a diagnostic marker of acute pyelonephritis in children

OBJECTIVE

Experimental evidence suggests that neutrophils and their metabolites play an important role in the pathogenesis of pyelonephritis. The aim of this study was to investigate the diagnostic value of polymorphonuclear elastase-a(1)-antitrypsin complex (E-a(1)-Pi) for the detection of acute pyelonephritis in children.

METHODS

Eighty-three patients, 29 boys and 54 girls, 25 days to 14 years of age, with first-time symptomatic urinary tract infection were prospectively studied. Fifty-seven healthy children served as controls. Dimercaptosuccinic acid (DMSA) scan and voiding cystourethrography were performed in all patients. Plasma and urinary E-a(1)-Pi, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophil count, urinary N-acetyl-beta-glucosaminidase (NAG), N-acetyl-beta-glucosaminidase b (NAG b), and creatinine levels were measured in all patients on admission and 3 days after the introduction of antibiotics. The same markers were also measured in the control subjects.

RESULTS

Planar DMSA scintigraphy demonstrated changes of acute pyelonephritis in 30 of 83 children (group A). It was normal in the remaining 53 children (group B). The sex and age distributions were not significantly different between the 2 groups, as well as between the patients and the control subjects (group C). Nineteen of the 53 children with a normal DMSA had body temperature >/=38 degrees C, whereas all but 4 children with abnormal DMSA had temperature >/=38 degrees C. Therefore, the temperature was significantly different between these 2 groups. The sensitivity and specificity of fever (>/=38 degrees C) as an indicator of renal involvement based on isotopic findings were 86% and 64%, respectively. Given the significant number of the febrile children with normal DMSA scintiscans, group B was subdivided into B(1) with 19 febrile children (14 boys and 5 girls) and B(2) with 34 children whose body temperature was below 38 degrees C (8 boys and 26 girls). The sex and age distribution was significantly different between groups B(1) and B(2). The mean age of group B(1) was.78 years (range: 28 days to 9 years; median:.25 years; standard deviation: 2.1). All but 1 child in this group were younger than 1 year of age. In contrast, in group B(2), there were only 4 infants, the remaining 30 children were older than 2.5 years (mean age: 6 years; median: 7 years; standard deviation: 3.5; range: 34 days to 12 years). The mean duration of fever before hospital admission was 2.8 days for group A and 1.8 days for group B(1). This difference was not statistically significant. Similarly, body temperature was not significantly different between these 2 groups. The distribution of plasma E-a(1)-Pi values was normal in the control subjects. The sensitivity and specificity of plasma E-a(1)-Pi, as an indicator of renal involvement, were 96% and 50%, respectively, taking the 95th percentile of the reference range as a cutoff value. However, considering as a cutoff value the level of 72 microg/dL (95th percentile of group B(2)), its sensitivity and specificity were 74% and 86%, respectively. Plasma E-a(1)-Pi levels were significantly elevated in group A compared with group B and in both groups, the plasma E-a(1)-Pi values were significantly higher than in the control subjects. A significant difference also was noticed between group A and each of the subgroups B(1) and B(2) and also between the subgroups themselves. Plasma E-a(1)-Pi concentrations correlated significantly with neutrophil count in groups A (r =.3), B (r =.4), and B(2) (r =.46), but the correlation was not significant in group B(1.) ESR levels showed, among the different groups, similar differences with those of E-a(1)-Pi values. Unlike E-a(1)-Pi, CRP levels were comparable between groups A and B(1), which both consisted of febrile children. Neutrophil count was not significantly different between subgroups B(1) and B(2). (ABSTRACT TRUNCATED)

A case of non-Fanconi anemia bone marrow dysfunction with familial involvement

We report on a Greek girl with pancytopenia, short stature, clinodactyly, cleft palate, exopthalmus, strabismus, café-au-lait spots, and mild mental retardation in whom chromosomal analysis excluded Fanconi anemia. The occurrence of erythroleukemia in the family and the presence of macrocytosis in her father and low blood counts in her sister favor the diagnosis of an inherited syndrome of familial marrow dysfunction rather than that of a sporadic case.

Arcanobacterium haemolyticum in children with presumed streptococcal pharyngotonsillitis or scarlet fever

Arcanobacterium haemolyticum was cultured from pharyngeal specimens obtained from 12 of 129 children with pharyngotonsillitis, some of whom had a scarlatiniform rash. This organism should be considered to be a cause of infections that are clinically similar to those caused by beta-hemolytic streptococci.

High mebendazole doses in pulmonary and hepatic hydatid disease

Thirty nine children with 71 hydatid cysts were given mebendazole orally in a dose of 100-200 mg/kg/day for 12 weeks and were followed up for a mean (SD) of 63 (24) months. Twenty children (three of them after a second course) were cured and another two avoided at least one operation. No serious side effects of the drug were observed.

[Cat-scratch disease associated with osteomyelitis]

A case of cat-scratch disease in an 8 year-old girl is reported. The inoculation injury followed by regional lymphadenopathy was typical of Parinaud syndrome. This patient also had vertebral lesions on scintigraphy, x-rays and CT scan. While the oculoglandular localization spontaneously improved within a few weeks, osteomyelitic lesions remained grossly unchanged after almost 2 years of follow-up.

Retarded skeletal maturation in Weaver syndrome

A male infant with primordial overgrowth and morphological characteristics of Weaver syndrome is presented. Unexpectedly his osseous maturation was retarded.

Radiation dose to the bladder wall and the gonads from direct radionuclide cystography in children

A dynamic spherical bladder model, previously developed in our laboratory, was implemented to evaluate the absorbed dose to the bladder wall from 99mTc-pertechnetate and direct radionuclide cystography (DRC). This model takes into account the flow rate of normal saline into the bladder and the bladder volume as a function of the filling time. The DRC examinations of 36 children were analysed and calculations were carried out in order to estimate (a) the absorbed dose to the bladder during and following the DRC examination and (b) the gonadal dose. It is shown that the estimated dose to the bladder wall is much greater than that estimated by static models. It is also shown that the absorbed dose to the bladder due to the activity in the residual urine following the examination is even greater than the dose received during the DRC procedure. Our results indicate that in order to reduce the radiation burden, besides the so far proposed precautions, concerning the shortening of the DRC procedure, the patient should also be well hydrated and encouraged to void frequently after the examination.

RES phagocytosis in children with homozygous beta-thalassemia in relation to blood transfusion

In order to investigate the effect of blood transfusion on the RE cell function in thalassemia major, 14 children with homozygous beta thalassemia were studied prior to and 7 to 10 d following blood transfusion, when, according to previous studies, spleen reaches its minimum size. The denatured human albumin (DHA) low and large dose clearance techniques were used in order to estimate the maximum RES phagocytic capacity. It is shown that, despite the confirmed post-transfusion high hepatosplenic circulation, the RE cell phagocytic capacity is not significantly affected. Furthermore the RES phagocytic capacity of beta-thalassemics is shown to be significantly higher than that of normal controls, and this can probably be attributed to the RES hyperplasia accompanying the disease.

Statistical aspects of hydatid disease in Greek adults

A retrospective study was undertaken to estimate the incidence of hydatidosis among Greeks over 18 years of age. Discharge and operating room records in all community and private hospitals during the period 1 January 1969 to 31 December 1975 were reviewed, and new hydatid patients were registered. Hydatid disease was diagnosed in 4,202 adults. The average annual incidence of all hospital cases was 9.77 per 100,000 population. The diagnosis was confirmed at surgery in 3,397 patients (80.84%). The average annual surgical incidence was 7.89 per 100,000 inhabitants. The incidence of the disease varied among different geographic areas in the country; its percentage was highest in rural areas. In this series, both sexes were equally involved (P greater than 0.1). Solitary organ involvement occurred in 95.88% of cases. Cysts were localized in the liver in 69.64% and in the lungs of 23.43% of the cases with single organ involvement. Liver involvement was more frequent in women, while lung involvement was more frequent in men (P less than 0.001).

Estimates of dose to the bladder during direct radionuclide cystography: concise communication

We estimate the absorbed dose to the bladder walls, Db, due to [99mTc]pertechnetate direct radionuclide cystography, with due consideration to the dynamic nature of the examination. Our analytical method resulted in Db values expressed as functions of the bladder filling time. These values are compared with published data based on a static bladder model. It is shown that the Db value depends strongly on the protocol under which the examination is carried out. It is also shown that the normal saline flow rate and the time of the administration of the radioactive material can be adjusted so that the radiation burden may be greatly reduced.

Grading of vesicoureteral reflux by radionuclide cystography

Thirty-six children with urinary tract infection aged 6 months to 14 years (mean age 4 1/2 years) were studied sequentially using direct radionuclide (RNC) and conventional voiding cystourethrography (VCU). Vesicoureteral reflux (VUR) was detected equally well by both methods. Twenty-seven refluxing ureters were found by RNC, 23 by VCU and 22 by both methods. Radiologic grade of reflux may be determined approximately with the isotope technique from the volume of regurgitating urine and duration of reflux, at a much decreased radiation exposure. Residual urine was also measured by RNC and found to be higher in children with VUR. RNC is a reliable method for detecting and grading VUR and should effectively replace VCU as the follow-up examination of choice.

Hydatid disease in asymptomatic young carriers in northern Greece

An epidemiological survey to determine the prevalence of echinococcosis in children and adolescents was made in Grevena County of northern Greece. Counterimmunoelectrophoresis was used to screen 2,736 school children whose ages ranged from 6-18 years; among them, three asymptomatic carriers were identified. The diagnosis was subsequently confirmed by liver radioisotope scanning. By extrapolation, we estimate that the point prevalence of hydatid disease in the asymptomatic population of the study area is 110 per 100,000.

Hydatid disease in Greek children

The surgical incidence of hydatidosis in the Greek population aged 0-18 years was investigated. Discharge and operating room records from 1 January 1969 through 31 December 1975 in all hospitals of the country were reviewed. Data were statistically analyzed according to geographical and annual distribution of the disease, age, sex, and organ affected. Of a total of 4,566 patients with hydatidosis, 534 (11.7%) were 0-18 years old. By extrapolation, operations in this age group were performed at a rate of 2.7/100,000 population per year. Surgical incidence of hydatidosis varies among different geographical areas in Greece; its percentage is highest in rural areas. The disease is more frequent in boys than in girls (P less than 0.01). Lungs and liver are the most commonly involved organs (94.2%). Lung involvement is more frequent in boys (73.0%) than in girls (50.5%) (P less than 0.001).

Spleen size changes in children with homozygous beta-thalassaemia in relation to blood transfusion

18 thalassaemic children, aged 3.5 to 13 years comprise our clinical material. In 14 of them clinically elicited spleen markings, haematocrit, blood platelet count and red cell morphology were studied daily for the whole period between transfusions. In 10 patients considerable changes in spleen size were noticed. According to out clinical observations the spleen size starts decreasing 1 to 3 d after blood transfusion up to the 10th posttransfusion day fluctuating thereafter to reach its maximum size again prior to the next blood transfusion. The decrease of spleen size was followed by an increase of haematocrit and blood platelet count and vice versa. 4 additional children were studied clinically only twice: prior to and 7 to 10 d after blood transfusion. A definite decrease of the spleen size following blood transfusion was observed. Spleen and liver 99mTc-sulfur colloid uptake was studied in 10 of the above children prior to and 7 to 10 d after blood transfusion. Statistically significant post-transfusion increase of the spleen uptake was demonstrated. Our findings suggest that (a) splenic size is relevant to blood volume sequestrated int this organ, (b) splenic radioactive uptake increases with its post-transfusion reduction in size.